Infusion Ready

This release updates clinical content across the catalog and the Y-site compatibility matrix following a source-checked review against FDA labelling. Compatibility verdicts, dedicated-line flags and concentration strings have changed, so re-check any pairing or dilution you rely on. DILUENT CAUTIONS - Norepinephrine with 0.9% sodium chloride, and with 0.45% sodium chloride, resolves as a caution rather than an incompatibility, and the card states why. The LEVOPHED label directs you to dilute in 5% Dextrose Injection, or a sodium chloride solution containing 5% dextrose, and says administration in saline alone is not recommended, because dextrose acts as the antioxidant and norepinephrine is subject to oxidative loss in dextrose-free saline. That is a labelling recommendation, not a documented physical incompatibility, and the card says so, so you can weigh it against your own practice. - Norepinephrine usual diluent reads D5W, or dextrose-containing sodium chloride (D5NS / D5 half-NS). COMPATIBILITY VERDICTS - Eptifibatide with furosemide resolves as documented Y-site incompatible. INTEGRILIN label: do not administer through the same intravenous line as furosemide. - Dexmedetomidine with liposomal amphotericin B, and with amphotericin B deoxycholate, resolves as documented Y-site incompatible, per the PRECEDEX label. - Cisatracurium with phenobarbital, and with pentobarbital, resolves as documented Y-site incompatible. NIMBEX label: acidic at pH 3.25 to 3.65, and may not be compatible with alkaline solutions above pH 8.5, such as barbiturates. DEDICATED LINES - 24 further infusions carry the dedicated-line flag, lock icon and dedicated line card, bringing the total to 43: lorazepam, 3% sodium chloride, Lactated Ringer's, albumin 5%, albumin 25%, hetastarch, mannitol 20%, insulin, ceftriaxone, tobramycin, amikacin, cefotaxime, caspofungin, voriconazole, moxifloxacin, 4-factor PCC, andexanet alfa, recombinant factor VIIa, ceftobiprole, meropenem-vaborbactam, rezafungin, remdesivir, tedizolid and oxacillin. - Insulin (regular) requires a dedicated line. Insulin with potassium chloride, 0.9% sodium chloride, 5% dextrose, 0.45% sodium chloride, D5 half-NS and D5NS resolves as requiring a dedicated line, as does norepinephrine with insulin. - The planner rationale for a dedicated drug quotes the own-line requirement from that drug's own note rather than a general class description. CONCENTRATIONS AND ADMINISTRATION - Angiotensin II: 2.5 mg/500 mL NS = 5,000 ng/mL. Dilute to 5,000 or 10,000 ng/mL. Starting dose 20 ng/kg/min. - Vancomycin: 1 g/250 mL (4 mg/mL), 1.5 g/300 mL (5 mg/mL), at or below 5 mg/mL and at or below 10 mg/min in adults. - Bivalirudin: reconstitute the 250 mg vial with 5 mL SWFI = 50 mg/mL, then dilute in 50 mL D5W or NS = 5 mg/mL. Low-rate infusion: dilute in 500 mL = 0.5 mg/mL. - Ganciclovir: reconstitute 500 mg with 10 mL SWFI = 50 mg/mL. Infusion concentrations greater than 10 mg/mL are not recommended. - Phenytoin: dilute in NS only, final concentration no less than 5 mg/mL, commonly 5 to 10 mg/mL. Use a 0.22 to 0.55 micron in-line filter. Infuse at or below 50 mg/min in adults. - Oritavancin: artificially prolongs aPTT for up to 120 hours, and PT/INR for up to 12 hours. NOTES AND CITATIONS - The normal saline and blood product notes match the planner: blood products are planned on a dedicated line, and 0.9% sodium chloride is used to prime or flush the transfusion set. - FDA labelling is listed as a citation source for the nine agents updated above, and for the label-documented Y-site incompatibilities recorded in the matrix. Y-site compatibility remains concentration-, diluent-, rate- and container-dependent. Confirm every co-administration with pharmacy for the actual ordered concentrations before infusions are connected.

The infusion catalog now covers 199 continuous IV infusions, adding newer and higher-acuity agents across antimicrobials (e.g., cefiderocol, meropenem-vaborbactam, aztreonam-avibactam, rezafungin, isavuconazole, dalbavancin, oritavancin), antidotes and reversal agents (idarucizumab, andexanet, digoxin immune Fab, dantrolene, pralidoxime, physostigmine), and additional cardiac, sedation, and critical-care drips. Every infusion and every Y-site verdict now shows its cited medical sources, with tappable links to the underlying references (Trissel's, King Guide, Micromedex) and, for newer agents, FDA prescribing information via DailyMed. Added documented Y-site incompatibilities for several new agents — including aminoglycoside-inactivating β-lactams, D5W-only lipoglycopeptides that precipitate in saline, and foscarnet with calcium-containing solutions. The conservative safety model is unchanged: infusions are only grouped when documented compatible, dedicated-line drugs are always isolated, and anything without reliable data stays on a separate line.